Robot-Assisted Transaxillary Right Thyroid Lobectomy

Robot-Assisted Transaxillary Right Thyroid Lobectomy

Daniah Bu Ali, MD; Fadi Murad, MD; Sang-Wook Kang, MD; Emad Kandil, MD

Tulane University School of Medicine, Department of Surgery

Objective: A 37 years old patient presented with right neck mass. Ultrasound showed a 3.9 cm right thyroid nodule with internal vascularity, and fine needle aspiration revealed hurthle cell neoplasm. The patient wanted to avoid neck scar due to history of keloid. Accordingly, we elected to proceed with robot-assisted transaxillary right thyroid lobectomy. The video illustrates the flap creation steps and robotic technique of the procedure.

Procedure: A 5cm incision was made in the right anterior axillary line and a subcutaneous flap was created. The vagus nerve was stimulated initially, and then the superior thyroid pedicle was dissected and divided using a vessel sealing device. The recurrent laryngeal nerve was identified after meticulous dissection and confirmed using the nerve stimulator. The inferior pedicel was then dissected and divided, and the thyroid lobe was shaved from the trachea using a vessel sealing device. At the end the right thyroid lobe and isthmus were separated from the left lobe and extracted through the axillary incision.

Results: The patient was discharged on the same day, and had an uneventful postoperative course.

Conclusion: Performing thyroid lobectomy via robot-assisted transaxillary approach is a safe and feasible technique for patients who prefer to avoid neck incision.